Obama looks to regain the offensive on health care reform

After a run of tough weeks, the Obama administration got a dollop of good news on health care reform Tuesday night. Even as congressional committees continued their hearings on the website debacle, and opponents hammered the president for his past misstatements on the cancellation of insurance plans, voters in Virginia elected an Obamacare enthusiast, Democrat Terry McAuliffe, as governor.

McAuliffe’s close victory over tea partier Ken Cuccinelli greatly improves the odds that 400,000 low-income Virginians will gain access to Medicaid next year. And though it won’t end the continuing nightmare that is healthcare.gov, the victory may also help move the president off of the defensive as he travels to Texas to push his signature initiative.

McAuliffe enthusiastically backed Medicaid expansion throughout the Virginia governor’s race. And like a growing number of swing-state governors, he made a pragmatic pitch as well as a moral one. “This common-sense policy is not only right morally, it’s good for the economy,” he said in a September statement. “It will provide 400,000 uninsured Virginians access to health insurance, will create an estimated 33,000 jobs, and will bring $21 billion of taxpayer funds back to Virginia.”

That’s not all it would do. Combined with other features of the Affordable Care Act, Medicaid expansion would reduce the number of uninsured Virginians—currently about 1 million—by half. And though the expansion would cost Virginia $1.3 billion over the coming decade, the state would receive $11 in federal support for every dollar invested. The expansion would also spare Virginia $400 million in unpaid medical bills over 10 years. And it would boost payments to the state’s hospitals by $6.1 billion. Like Texas Governor Rick Perry, Cuccinelli told voters they couldn’t afford to make the investment. Many now seem to realize they can’t afford not to.

While McAuliffe’s victory may brighten the prospects for expanding health coverage in Virginia, it doesn’t guarantee success. This year, under Gov. Bob McDonnell, the state created a bipartisan Medicaid Innovation and Reform Commission to ensure that any expansion proposal includes extensive reforms in the state’s current Medicaid program. The commission includes five voting members from each house of the Virginia legislature, and both five-member groups must approve any plan McAuliffe submits to the feds. Supporters are predicting brisk progress after McAuliffe takes office in January, but he’ll need support from both parties to move forward. Until then, most of Virginia’s poorest adults will fall into the same luckless zone as those in other states that have yet to expand Medicaid. They won’t qualify for subsidized coverage through private insurers, and they won’t qualify for public coverage either.

Some 1.2 million Texans face the same dilemma, and hundreds of thousands of them live in Dallas County, where the president spoke on Wednesday. His visit—one of many that administration officials have staged in Texas recently—serves partly to remind the public how easily Governor Perry could close the gap in coverage. By expanding its Medicaid program, Texas could cover more than a million uninsured people next year—entirely at federal expense. The expansion would cost the state $5.7 billion over the next decade, as the federal share of expansion costs falls gradually to 90%. But the investment would draw nearly $66 billion in federal support while sparing the state unpaid medical bills and strengthening its health care sector.

“This is a no-brainer,” the president said in Dallas on Wednesday evening, encouraging his audience to push state leaders to embrace the expansion program. San Antonio Mayor Julian Castro echoed the call in a post on the White House blog. “Usually, we do things bigger in Texas,” he wrote. “But right now, when it comes to covering the uninsured, some of our neighboring states are trying to beat us to the draw.”

Only a third of Texans approve of the Affordable Care Act, according to polling results released Wednesday by the University of Texas and Texas Tribune. Yet three-quarters favor public subsidies to help low-income consumers buy health insurance through the exchanges, and two-thirds agree that states should have the option of extending Medicaid coverage to impoverished adults.

Overall, American support for Obamacare seems to be growing. A new Ipsos/Reuters poll Wednesday found that 47.1% of respondents viewed the new health care law favorably, compared to 43.8% in September. The trend is even more positive among the uninsured– 44% now support the law, compared to 36.8% in September.

While highlighting what Obamacare could do for Texas, the president also touted what is already changing. Local governments and grassroots organizations have worked closely with federal health officials to link uninsured Texans to the state’s health insurance exchange. And thanks to the Affordable Care Act, more than 2 million of them will qualify for tax credits to subsidize their coverage next year. Until healthcare.gov is working as advertised, that storyline will carry some dark irony. But it underlines a fact the administration is desperate to reassert: the website may be broken, but the health care law is still sound.